Provider Demographics
NPI:1891225827
Name:SACKS, FANNY (DC LAC)
Entity type:Individual
Prefix:MS
First Name:FANNY
Middle Name:
Last Name:SACKS
Suffix:
Gender:F
Credentials:DC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 AURORA DR
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-3173
Mailing Address - Country:US
Mailing Address - Phone:607-316-0944
Mailing Address - Fax:
Practice Address - Street 1:4939 STATE HWY 23
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815
Practice Address - Country:US
Practice Address - Phone:607-373-3797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007383111N00000X
NY005636171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111N00000XChiropractic ProvidersChiropractor